| NPI | 1871971309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH 7159) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: OH 7159) |
| 103TF0000X Psychologist, Family (Licence: OH 7159) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: OH 7159) | |
| 103TC0700X Psychologist, Clinical (Licence: OH 7159) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: OH 7159) | |
| Enumeration Date | 2015-05-17 |
| Last Update Date | 2023-06-07 |